By Mary Carpenter
MARIJUANA is back in the news: in DC, with proposals to restrict and fine “pot-gifting” —adding marijuana as a “gift” to purchases, such as a $50 bottle of apple juice, as a lower-price and easier-to-access alternative to medical dispensaries. And in New Jersey, medical marijuana companies have just received the go-ahead to sell to all adults—without needing a doctor’s okay — although the approval at first covers only sales of “medical marijuana.”
(Compared to recreational marijuana, cannabis destined for medical use differs mostly in the oversight of production methods, such as controlled indoor environments and strictly monitored pesticides. But in states like California, clients interested in medical as well as psychoactive effects often purchase the same products, such as low-dose lozenges made by Kiva that come with health claims including “mood enhancing” and “tranquil night.” )
Also in recent news, University of Chicago researchers have observed Covid protection using CBD—although in doses so high as to be exorbitantly expensive for humans, and in studies of human lung cells rather than actual humans. (CBD, one of the cannabinoids in marijuana, does not produce psychoactive effects.) CBD appeared to activate a cellular stress response—typically triggered in the presence of viruses and other pathogens, involving interferons — that prevented entry of the coronavirus into cells.
In addition, a review of 1,212 patients from the National COVID Cohort Collaborative found a 6% infection rate among people taking pharmaceutical grade CBD—compared to 8.9% for those not taking CBD. But other researchers said the acids that bind to Covid-19’s spike protein exist in the raw cannabis plant but are destroyed in processing and not generally present in commercially available products.
Meanwhile, cannabis enthusiasts claim benefits for everything from weight loss to focus, sleep, anxiety and depression—although respected clinical studies have not confirmed these effects. One exception is CBD’s successful treatment of some forms of epilepsy, which led to FDA approval, adding to enthusiasts’ belief in marijuana’s other health effects.
Medical cannabis proved successful, according to a recent Johns Hopkins survey, in reducing emergency room visits for more than 800 users— making them 39% less likely to have visited an ER in the month before being surveyed, compared to a control group of more than 460 people not using marijuana medically. In the survey taken before and after medical cannabis use and in comparison with non-users, the marijuana group reported about a 9% reduction in pain and a 12% reduction in anxiety, as well as a 14% lower use of prescription medicines.
Pain control is the most common reason for medical marijuana use in the U.S., according to Harvard professor and Medical Letter blogger Peter Grinspoon. While not strong enough for severe pain, such as post-surgery, marijuana is “quite effective,” Grinspoon writes, for chronic pain…and nerve pain in general; for nerve pain as a good alternative to highly sedating opiates; and instead of NSAIDs, for people who suffer side effects, such as stomach pain or GERD, from these medications.
But sleep problems drive many to seek respite from marijuana—including San Francisco-based tech manager P.D., whose doctor prescribed low-dose THC to take in combination with melatonin for help with restless nights. Marijuana, writes Valeriya Safronova, “can start the day, end it or prolong it.”
Non-medical products from California-based Dosist have names like “sleep,” and “bliss.” And Fit gummies created by Wana Brands in Colorado claim to “disrupt unhelpful eating habits,” i.e., help with weight loss. Supporting research offered by Wana Brands, however, lists investigators and trials for which there is no record at N.I.H, as required; and efforts by the New York Times to track these down were unsuccessful.
“The science is very far behind the marketing and the public consumption,” said Margaret Haney, co-director of the Substance Use Research Center at Columbia University. Cannabis research is fraught with difficulty because of different individuals’ reactions to marijuana, as well as problems with product consistency— in quality and dosing— and very limited sourcing for federally approved experimentation.
Meanwhile, warnings from the American Heart Association (AHA) link cannabis use to heart attack, atrial fibrillation and stroke— although these may in fact be due to effects of inhaling or vaping that also occur with tobacco products. Acknowledged AHA spokesperson, Colorado pharmacy and rehabilitative medicine professor Thomas Page, “Unfortunately, most of the available data are short-term, observational and retrospective studies, which identify trends but do not prove cause and effect.”
An additional 2022 AHA statement reported that marijuana’s effects on the brain—in animal studies—have included thinning of brain areas involved in orchestrating thoughts and actions as well as disruption of memory and learning.
But short-term effects on memory are what might make marijuana helpful for veterans suffering PTSD, which involves “unpleasant, intrusive memories that people can’t help but remember,” writes Grinspoon, who also points out that “memory returns to normal with abstinence.” Grinspoon considers marijuana a “fantastic muscle relaxant” and describes marijuana’s ability to lessen tremors in Parkinson’s disease patients.
The body’s endocannabinoid system (ECS) is “critical for almost every aspect of our moment-to-moment functioning,” Grinspoon explains. Cannabinoid receptors in the brain (CB1 receptors) help control levels and activity of most other neurotransmitters, while a second type, CB2, “exists in our immune tissues” —which could be the link to Covid protection.
“The medical community has been, as a whole, overly dismissive of [medical marijuana],” according to Grinspoon, who encourages patients to talk with their doctors about potential uses of marijuana for various health issues. “I often hear complaints from other doctors that there isn’t adequate evidence to recommend medical marijuana,” he writes, “but there is even less scientific evidence for sticking our heads in the sand.”
And while questions about inadequate evidence for marijuana’s effects help fuel controversies surrounding marijuana dispensaries—including issues like “pot-gifting”—what most people are fighting about is profits. Companies like Wana appear to take advantage of the confusion—but customers who find relief from the products may be the ultimate victims.
On trips to Colorado and California, I have purchased low-dose marijuana lozenges that help me with sleep. With Kiva mints in California, I appreciated being able to rely on dosage—a low 2.5 mg.; as well as on effects —slightly drowsy, whereas a local friend’s concoctions make wild images speed through my brain. But because federal law prohibits both sending these by mail and traveling with them across state lines, I must travel to obtain this relief.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.